Soft tissue repair assembly and associated method

ABSTRACT

A soft tissue repair assembly. The assembly includes a flexible member having first and second ends, and a strand passing through the flexible member. The strand has first and second strand ends extending through the flexible member, such that pulling at least one of the first and second strand ends changes the flexible member from a first shape suitable for insertion through soft tissue to a second shape suitable for securely lodging the soft tissue repair assembly relative to soft tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/828,977 filed Jul. 1, 2010, which is a divisional of U.S. patentapplication Ser. No. 11/347,661 filed on Feb. 3, 2006, now U.S. Pat. No.7,749,250 issued on Jul. 6, 2010. The entire disclosure of the aboveapplication is incorporated herein by reference.

INTRODUCTION

Tears caused by trauma or disease in soft tissue, such as cartilage,ligament, or muscle, can be repaired by suturing. Various assemblieshave been developed for facilitating suturing and are effective fortheir intended purposes. Nevertheless, tissue repair assemblies forfacilitating suturing are still desirable.

SUMMARY

The present teachings provide a soft tissue repair assembly. Theassembly includes a flexible member having first and second ends, and aflexible strand passing through the flexible member. The strand hasfirst and second strand ends extending through the flexible member, suchthat pulling at least one of the first and second strand ends changesthe flexible member from a first shape suitable for insertion throughsoft tissue to a second shape suitable for securely lodging the softtissue repair assembly relative to soft tissue.

The present teachings provide a soft tissue repair assembly thatincludes an inserter, at least one flexible member preloaded on theinserter in a first shape, and a flexible strand coupled to the flexiblemember for changing the shape of the flexible member from the firstshape to a second shape after implantation, wherein the second shape issuitable for securely lodging the flexible member relative to softtissue.

The present teachings provide a method for repairing a tear in softtissue. The method includes preloading a flexible member coupled to aflexible strand on an inserter, inserting the inserter through tissuefrom a first side of the tear to a second side of the tear, anddeploying the flexible member relative to the soft tissue. The methodfurther includes tensioning the strand, changing the shape of theflexible member from a first shape to a second shape suitable forsecurely lodging the flexible member relative to the soft tissue, andreducing or closing the tear.

The present teachings provide a method for repairing a tear in ameniscus during arthroscopic knee procedure. The method includesinserting an inserter through the tear to an outer surface of themeniscus, deploying a first flexible member coupled to a flexible strandfrom the inserter on an outer surface of the meniscus, tensioning thestrand, changing the shape of the first flexible member from a firstshape to a second shape for securing the flexible member on the outersurface, and reducing or closing the tear.

Further areas of applicability of the present invention will becomeapparent from the description provided hereinafter. It should beunderstood that the description and specific examples are intended forpurposes of illustration only and are not intended to limit the scope ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is an exploded view of a soft-tissue repair assembly according tothe present teachings;

FIG. 2 is a perspective view of a soft-tissue repair assembly accordingto the present teachings, shown in a first shape;

FIG. 3 is a perspective view of the soft-tissue repair assembly of FIG.2, shown in a second shape;

FIG. 4 is an environmental view of the soft-tissue repair assembly ofFIG. 2, shown implanted relative to soft tissue;

FIG. 5 is a perspective view of a plurality of connected soft-tissuerepair assemblies according to the present teachings shown in firstshapes;

FIG. 6 is an environmental view of the soft-tissue repair assemblies ofFIG. 5, shown in second shapes and implanted relative to soft tissue;

FIG. 7A is a plan view of a soft-tissue repair assembly according to thepresent teachings, shown in a first shape;

FIG. 7B is a plan view of the soft-tissue repair assembly of FIG. 7A,shown in a second shape;

FIG. 7C is a plan view of a soft-tissue repair assembly according to thepresent teachings, shown in a first shape;

FIG. 7D is a plan view of the soft-tissue repair assembly of FIG. 7C,shown in a second shape;

FIG. 7E is a plan view of a soft-tissue repair assembly according to thepresent teachings, shown in a first shape;

FIG. 7F is a plan view of the soft-tissue repair assembly of FIG. 7A,shown in a second shape;

FIG. 7G is a plan view of a soft-tissue repair assembly according to thepresent teachings;

FIG. 7H is a plan view of a soft-tissue repair assembly according to thepresent teachings, shown in a first shape;

FIG. 7I is a plan view of the soft-tissue repair assembly of FIG. 7H,shown in a second shape;

FIG. 7J is a plan view of a soft-tissue repair assembly according to thepresent teachings;

FIG. 7K is a plan view of a soft-tissue repair assembly according to thepresent teachings;

FIG. 8A is a plan view of an inserter according to the presentteachings;

FIG. 8B is a side view of the inserter of FIG. 8A;

FIG. 9A is a plan view of an inserter according to the presentteachings;

FIG. 9B is a side view of the inserter of FIG. 9A;

FIG. 10 is a side view of an inserter shown holding a soft-tissue repairassembly according to the present teachings;

FIG. 10A is a perspective view of an exemplary inserter, according tothe present teachings;

FIG. 11 is a side view of an inserter shown holding two soft-tissuerepair assemblies according to the present teachings;

FIG. 11A is a side view of an inserter shown holding two soft-tissuerepair assemblies according to the present teachings;

FIG. 12 is a side view of an inserter shown holding a soft-tissue repairassembly according to the present teachings;

FIG. 13 is a side view of an inserter shown holding a soft-tissue repairassembly according to the present teachings;

FIG. 14 is a plan view of an inserter shown holding a soft-tissue repairassembly according to the present teachings;

FIG. 15 is a plan view of an inserter shown holding a soft-tissue repairassembly according to the present teachings;

FIG. 16 is a perspective view of a soft-tissue repair assembly accordingto the present teachings;

FIG. 17 is a perspective view of a soft-tissue repair assembly accordingto the present teachings;

FIG. 18 is a perspective view of a soft-tissue repair assembly accordingto the present teachings;

FIG. 19 is an environmental view of a soft-tissue repair assemblyaccording to the present teachings; and

FIG. 20 is an environmental view of a soft-tissue repair assemblyaccording to the present teachings.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no wayintended to limit the invention, its application, or uses. For example,although the present teachings are illustrated in an application formeniscus repair in knee surgery, the present teachings can also be usedfor repairing any tissue, such as bone, muscle, ligament or tendon in anarthroscopic or other open procedure.

Referring to FIG. 1 and FIG. 7E, an exemplary soft tissue repairassembly 100 according to the present teachings can include a flexiblemember 102, and a flexible strand 103, such as, for example, thread,ligament, wire, or suture. The strand 103 can be coupled with theflexible member 102 for changing the shape of the flexible member 102.The flexible member 102 can be an elongated member having first andsecond ends 107, 109. The elongated member can include a substantiallycylindrical wall 111 having a longitudinal bore 105, as illustrated inFIG. 1, or can be a flexible elongated solid member 102 with a bore, asillustrated in FIG. 7E, or any other shape. The flexible member 102 canbe made of resorbable or non-resorbable materials, including sponges andsponge-like materials in solid form, perforated materials, woven/braidedfrom biocompatible materials or fibers, such as, for example, polymer,polyester, polyethylene, cotton, silk, or other natural or syntheticmaterials, include sponges and sponge-like materials. The flexiblemember 102 can also be an elongated tubular or solid member or atwo-dimensional member with or without internal bores. The flexiblemember 102 can have any properties that allow the flexible member 102 tochange shape. The flexible member 102 can be, for example, compliant,flexible, foldable, squashable, squeezable, deformable, limp, flaccid,elastic, low-modulus, soft, spongy, perforated or any other flexiblemember which can change shape. In some aspects, the flexible member 102can be coated with biological or biocompatible coatings, and it can alsobe soaked in platelets and other biologics, which can be easily absorbedby the flexible member 102 in particular when, for example, the flexiblemember 102 is made from spongy, absorbent material.

Referring to FIGS. 1-4, the flexible strand 103 can include an innerloop portion 104 and outer strand portion 106. The inner loop portion104 can be substantially contained within the bore 105, such that theinner loop portion 104 extends from the first end 107 of the bore 105,passes through the bore 105, and terminates at the second end 109 of thebore 105. The outer strand portion 106 can be coupled to the loopportion 104 adjacent the first and second ends 107, 109 and can extendsubstantially outside the flexible member 102.

The strand 103 can be made of braided filaments or fibers ofbiocompatible material, including natural and synthetic fibers, such ascotton, silk, polymer, polyester, polyethylene, and other materials. Theinner loop portion 104 can be knotted, as shown in FIG. 1, orcontinuous, as shown in FIG. 2. The outer strand portion 106 can be aseparate piece of strand 103 and can include first and second ends 106a, 106 b. Pulling at the ends 106 a, 106 b, or at least one of the ends106 a, 106 b while holding the other end fixed, when the flexible member102 is implanted relative to soft tissue or on an outer surface of softtissue causes the flexible member 102 to change shape from a first shapeto a second or implanted shape. The first shape of the flexible member102 can be a thin elongated shape with length to width (aspect ratio)greater than one. The first shape of the flexible member 102 can also bea folded shape. The implanted shape of the flexible member 102 can be abulkier shape with length to width ratio close to one, as illustrated inFIGS. 3 and 4, for snugly securing the flexible member 102 relative toor on an outer surface of soft tissue 80. The implanted shape of theflexible member 102 can have bigger overall width or enclosedcross-sectional area or volume than those of the first shape such thatthe flexible member 102 cannot be pulled out of the same opening throughwhich it was originally inserted. In one aspect, the flexible member 102can retain its bulkier shape after implantation, even after the tensionon the strand portion 106 is removed.

In the exemplary illustration of FIG. 4, the soft-tissue repair assembly100 is shown implanted on an outer surface 84, such as a posteriorsurface of a meniscal soft tissue 80, after passing through a tear 82for reducing or closing the tear 82. In FIG. 4, the suture securingsecond shape of the flexible member 102 is substantially a circularshape, but having a slit or gap 101. Referring to FIGS. 5 and 6,multiple soft tissue repair assemblies 100 can be daisy-chained togetherby a single continuous outer strand portion 106 connected to each innerloop portion 104 for reducing the tear 82. Generally, the soft-tissuerepair assembly 100 can be positioned relative to soft tissue, such asin the soft tissue, adjacent the soft tissue, or on an outer surface ofthe soft tissue.

Referring to FIG. 7A, a continuous strand 110 can be used to define aninner loop having an outer portion and loop ends 110 a, 110 b. After thestrand 110 is looped around the bore 105 of the flexible member 102,such that the first and second ends 107, 109 of the flexible member 102are coupled by the outer portion of the strand 110, the loop ends 110 a,110 b of the continuous strand 110 exit the bore 105 through small wallopenings 108 a, 108 b adjacent but displaced from the ends 107, 109 ofthe flexible member 102. A second strand 106 having ends 106 a, 106 b islooped around the loop ends 110 a, 110 b. Pulling the ends 106 a, 106 b,of the second strand 106 causes the flexible member 102 to change shapeto an eight-like securing shape, which appears pinched in the vicinityof the openings 108 a, 108 b, as illustrated in FIG. 7B. The eight-likeshape of the flexible member 102 provides a geometry that enclosesbigger area or volume for the same length of flexible member. Biggersecuring volume can prevent the flexible member 102 from being pulledout of the insertion opening, and can provide secure and stronganchoring in various applications at the discretion of the surgeon.

Referring to FIGS. 7C and 7D, a continuous strand 110 can be passedthrough the bore 105 of the flexible member 102, such the strand ends110 a, 110 b exit through wall openings 113 defined away from theflexible member ends 107, 109, in a middle section of the flexiblemember 102, such that pulling the strand ends 110 a, 110 b away from theflexible member 102, causes the flexible member 102 to change shape intoa pretzel-like securing shape, which can be selected for applicationwhen bigger enclosed area/volume is desired for the same length offlexible member 102. It will be appreciated that the wall openings 113,as well as the wall openings 108 a, 108 b discussed above in connectionwith FIGS. 7A, 7B, do not need to be preformed holes. The wall openings113, 108 a, 108 b, can be for example, space between fibers when theflexible member is woven or braided. The strand 110 can be passedthrough the wall 111 or between woven/braided fibers of the flexiblemember 102 using a suture threader, for example, or other instrument.The wall openings 108 a, 108 b and 113 can allow the flexible member 102to slide relatively freely along at least a portion of the strand 110,thereby helping to position the strand 110 before changing the shape ofthe flexible member 102 to the final implantation and suture securingshape.

It will be appreciated that various soft-tissue suture securing shapes,including those described above as well as other shapes, can be usedwith the same flexible member 102 by varying the manner of looping thestrand or strand portions or separate strands relative to the flexiblemember 102, and varying the number and/or location of various openings,such as the openings 108 a, 108 b, 113 described above, for producing adesired suture-securing shape. Generally, the suture-securing shapeshave a bulky shape and occupy a greater volume for securing the flexiblemember 102 snuggly into soft tissue. Furthermore, the flexible member102 lacks any sharp or cutting elements, sharp points, edges, or planes,such as barbs, hooks, fins, pins, threads, ribs, or othertissue-piercing features, generally associated sharp-element anchoring.Accordingly, the soft tissue repair assembly 102, in its various shapes,does not pierce or cut or otherwise injure soft tissue, and does notrely on sharp-element anchoring for securing suture into soft tissue. Onthe contrary, the soft-tissue repair assembly 100 provides suturesecuring that can be effected by changing the shape of the flexiblemember 102 into a bulkier second shape, which is relatively smooth andlacks any sharp elements or geometric features. In the bulkier shape theflexible member 102 can be lodged tightly outside soft tissue, or in orbetween layers of soft tissue, possibly displacing soft tissue, butwithout piercing, cutting or otherwise damaging soft tissue. In thebulkier shape, the flexible member 102 can be prevented from backing outof the original insertion opening, or tearing through tissue.

Referring to FIGS. 7E-7G, the elongated flexible member 102 can becoupled with a flexible strand 103 which can be retained with a buttonor knot or other retainer 140 adjacent a first end 107 of the flexiblemember 102 and then threaded in and out of the flexible member 102 alonga longitudinal axis A of the flexible member 102 exiting adjacent asecond end 109 of the flexible member 102. Pulling the strand 103 awayfrom the retainer 140 can cause the flexible member 102 to scrunch upagainst the retainer 140 in a wavy, zigzag, multifold or accordion-likefashion, as illustrated in FIGS. 7F and 7G. The flexile member 102 canhave a solid or annular cross-section.

Referring to FIGS. 7H-7K, the flexible member 102 can have asubstantially flat, planar or generally two-dimensional shape, formed,for example, as a flat sponge or a piece of woven fabric or otherflaccid material which can be pierced for passing a single strand 110therethrough, as illustrated in FIG. 7J, or for passing a strand loop104 coupled with an open strand 106, as illustrated in FIG. 7H. A pieceof strand 103 can be passed through the flexible member 102 in variousother configurations, including, for example, the configurationillustrated in FIG. 9K. Pulling at least one the strand 103, 106, 110can cause the flexible member 102 to change shape. FIG. 7I, for example,illustrates the new shape of the flexible member 102 of FIG. 7H, aftertensioning the strand 106.

Referring to FIGS. 8A-15, various instruments can be used for implantingone or more soft tissue assemblies 100 relative to soft tissue. FIGS.8A, 8B and 14 illustrate an inserter 120 having a rounded angled tipsurface 124 and a shaft 121 defining a cutout or groove 122. The groove122 can be configured for supporting a single flexible member 102 in abent or folded shape draped over the groove 122, as illustrated in FIG.14. FIGS. 9A, 9B and 15, illustrate a similar inserter 120 having asubstantially rectangular angled tip surface 124. A sleeve 125 can beplaced over the flexible member 102 to protect and keep the flexiblemember 102 and the strand 106 on the inserter 120, as illustrated inFIG. 15.

Referring to FIGS. 10, 10A, 11 and 11A, one or more soft tissueassemblies 100 can be preloaded in a tubular inserter 130, such as theexemplary inserter 130 illustrated in FIG. 10A. The inserter 130 caninclude a handle 145 with a slider 137 and a shaft carrying a needle 139having a bore 132. The flexible members 102 of the soft tissueassemblies 100 can be pushed out of the bore 132 using a plunger, aflexible pusher, such as a nitinol pusher, or other similar tool 131operated by the slider 137. Referring to FIG. 11A, in an exemplaryaspect two flexible members 102 are shown preloaded in the bore 132 ofthe needle 139 ahead of a stop 133. The flexible members 102 can becoupled by a strand 106 with a pre-knotted slip knot as discussed above,and can be separated by a curved end 141 of the flexible pusher 131. Thecurved end 141 of the flexible pusher 131 can push the first flexiblemember 102 out of the needle 139. The curved end 141 of the flexiblepusher 131 can be straightened out as the flexible pusher 131 isretracted under the second flexible member 102, and positioned ahead ofthe stop 133 for pushing the second flexible member 102 out of theneedle 139. Referring to FIG. 12, in another aspect, a single softtissue assembly 100 can be loaded on a fork of a forked inserter 136.

In an exemplary soft tissue repair procedure, such as repair of ameniscal tear 82, one of the inserters 120, 130, 136, pre-loaded with atleast one soft tissue repair assembly 100, can be inserted through aknee incision and through the meniscal tear 82. The flexible member 102with the strand 106 coupled thereto can be implanted past the tear 82 onthe posterior or outer surface 84 of the meniscal soft tissue 80, asillustrated, for example, in FIG. 4. The inserter 120, 130, 136 can thenbe removed leaving the strand ends 106 a, 106 b extending through thetear 82. Pulling the strand ends 106 a, 106 b away from the tear 82,causes the flexible member 102 to change shape into a suture securingshape, as discussed above, securely lodged on the outer surface softtissue, without piercing, cutting or otherwise damaging tissue. Thepulling action of the strand 106 reduces or closes the opening of thetear 82. Multiple soft-tissue repair assemblies 100 can be similarlyimplanted in daisy-chain fashion, as illustrated in FIG. 6, using thetubular inserter 130 with the multiple repair assemblies pre-loadedtherein, or one by one, disconnectedly. Similar implanting procedurescan be used for the soft-tissue repair assemblies 100 illustrated inFIGS. 7A, 7C, 7E, 7G, 7H, 7I and 7K. After implantation, the strand ends106 a, 106 b or 110 a, 110 b can be secured with a knot, such as, forexample, a pre-tied, self-locking slip knot, or other knot, andoptionally with the help of a retainer, such as a retaining button,anchor, or other auxiliary retaining device (not shown).

During insertion and before implantation, the flexible member 102 can besupported and maintained in the bore 132 of the tubular inserter 130 ina linear shape, as illustrated in FIGS. 10, 11 and 11A. After deploymentfrom the tubular inserter 130 for implantation relative to tissue, theflexible member 102 can change shape from a first shape into a secondsecuring shape of curvilinear profile by tensioning the strand 106. Inanother aspect, the flexible member 102 can be supported or draped onthe grooved inserter 120 or on the forked inserter 136 in asubstantially folded or U-shape, as illustrated in FIGS. 14, 15 and 12.After deployment from the grooved inserter 120 or the forked inserter136 for implantation relative to tissue, the flexible member 102 can bechanged into a securing shape of curvilinear profile by tensioning thestrand 106, as described above. It is noted that the substantiallyfolded or U-shape, which is used with the grooved inserter 120 or theforked inserter 136 for loading the flexible member 102, is anintermediate shape between the first linear shape, and the securingshape of curvilinear profile that provides a bulky shape for securelylodging the flexible member 102 into tissue.

In another aspect, and referring to FIGS. 16-20, a soft-tissue repairassembly 100 can include one or more linear pipettes or pipette segments150 over a strand 154 that can be used to reduce or close the tear 82.The repair-promoting pipette 150 can be made of resorbable ornon-resorbable polymeric materials, collagen, allograft, such assegments of arteries or veins, or other solid-wall or woven/braidedporous materials. The pipette 150 can also include perforations 162 forpromoting additional biological flow. The strand 154 can pass throughthe tear 82 for reducing the opening of the tear 82, and can be securedwith a knot 156. The soft-tissue repair assembly 100 can include one ormore soft-tissue repair-promoting small tubes or pipettes 150, which cancreate conduits for vascularization and/or flow of nutrients, blood andother biological fluids and substances.

Referring to FIG. 16, for example, the strand 154 can enter and passthrough a first pipette 150 in one direction, pass through strand loop104 of a first flexible member 102, pass through the first pipette 150in the opposite direction and exit the first pipette 150, and similarlypass through the second pipette 150, the second flexible member 102, andout of the second pipette 150, as illustrated by the directional arrowsalong the strand 154.

Referring to FIG. 17, a single U-shaped pipette 150 can be used to runalong the strand 154 between two flexible members 102. The strand ends154 a, 154 b can exit the pipette 152 through small openings 153 at thebottom of the “U”. The U-shape can be provided by using an originallystraight, but flexible/compliant pipette 150 that changes shape whilefollowing the U-shaped portion of the strand 154 between the twoflexible members 102, or by providing an originally curved pipette 150.

Referring to FIGS. 18 and 20, a single pipette 150 can be used with oneflexible member 102, with the strand 154 entering and exiting thepipette 150 in opposite directions before and after passing through thesuture loop 104 of the flexible member 102. The flexible member 102 canbe optionally used, or can be omitted entirely, as indicated by phantomlines in FIG. 20. Referring to FIG. 19, two pipettes 150 can be usedover corresponding portions of the suture 154, with or without the useof flexible members 102. Additionally, one or more pipettes 150 can beused independently without any suture or strand 154 passing therethroughfor promoting vascularization and healing.

Referring to FIGS. 4 and 6, the tissue repair assembly 100 can be used,for example, for implanting one flexible member 102, or multipleflexible members 102 for meniscal repair in an arthroscopic kneeprocedure. Referring to FIG. 4 an exemplary repair using a singleflexible member 102 is illustrated. The flexible member 102 can beimplanted using one of the inserters 120, 130, 136 discussed above andillustrated in FIGS. 8-15. The inserter 120, 130, 136 can inserted, withthe flexible member 102 pre-loaded in a first shape, as discussed above,into meniscal tissue 80 through the meniscal tear 82. The flexiblemember 102 can be deployed from the inserter 120, 130, 136 by manualmeans or pushing the plunger 131 or other deploying device, andimplanted on the posterior or outer surface 84 of the meniscal tissue 80of the knee. The inserter 120, 130, 136 can be then withdrawn. At leastone of ends 106 a, 106 b of the strand 106 can be pulled, causing theflexible member 102 to change to a second shape, as described above inconnection with FIGS. 3, 4, 4A-7D. The thus-shaped flexible member 102provides resistance against the outer meniscal surface 84, such thatfurther tensioning the strand 106, causes the tear 82 to be reduced orclosed. A slip knot, similar to the knot 156 illustrated in FIG. 20, andor another retaining device, such as a soft tissue anchor can be used tosecure the strand 106 or the ends 106 a, 106 b to tissue.

Referring to FIGS. 6, 11, and 11A, the tubular inserter 130 can be usedto implant multiple flexible members 102 on the posterior or other outersurface 84 of the meniscal tissue 80. The tubular inserter 130 canpre-loaded with multiple flexible members 102, which assume a firstshape during loading and insertion, and which are coupled therebetweenby the strand 106. After the first flexible member 102 is deployed fromthe inserter 130, as described above, in a first position on the outersurface 84, the inserter 130 can be withdrawn, re-inserted through themeniscal tear 82 and used to deploy a second flexible member 102 at asecond position spaced apart from the first flexible member 102. Afterthe last flexible member 102 is similarly deployed, the inserter 130 canbe withdrawn, and the strand 106 tensioned by pulling one or both endsaway from the tear 82, as illustrated in FIG. 6. Tensioning the strand106 causes each of the flexible members 102 change to a second shape,thereby resisting further tensioning and causing the tear 82 to bereduced or closed.

The tubular inserter 130 can be similarly used to deploy one or morepipettes 150 independently, or with strands 154 and with or without oneor more flexible members 102 for the configurations illustrated in FIGS.16-20.

It will be appreciated that the soft-tissue repair assembly 100 of thepresent teachings provides an economically efficient, effective andversatile device for securing suture relative to soft tissue andrepairing associated tears. Furthermore, the soft-tissue repair assembly100 avoids or reduces tissue damage and relies on its rounded secondshape for snug securing into tissue after implantation. Implantation canbe facilitated by using an inserter according to the present teachings,and providing one or more flexible members 102 and connecting suturepre-loaded thereon. The new tissue repair techniques associated with thetissue repair assembly of the present teachings rely on existing surgeonskills and can be easily mastered.

The foregoing discussion discloses and describes merely exemplaryarrangements of the present invention. One skilled in the art willreadily recognize from such discussion, and from the accompanyingdrawings and claims, that various changes, modifications and variationscan be made therein without departing from the spirit and scope of theinvention as defined in the following claims.

1.-18. (canceled)
 19. A method of repairing tissue, comprising:implanting a tissue repair apparatus in a patient to connect a firsttissue region to a second tissue region, the first tissue region spacedapart from the second tissue region in the patient, the tissue repairapparatus comprising: a first anchor member; a second anchor member; anelongated tubular implant; and a suture assembly coupled to the firstanchor member and the second anchor member and extending longitudinallythrough the elongated tubular implant between the first anchor memberand the second anchor member, the suture assembly including a first freeend that is located outside the elongated tubular implant via a firstportion of the suture assembly passing through a first side wall openingin the elongated tubular implant, the first side wall opening positionedbetween a first end of the elongated tubular implant and a second end ofthe elongated tubular implant, wherein said implanting leaves the firstanchor member in the first tissue region and the second anchor member inthe second tissue region; and pulling the first free end of the sutureassembly so as to tension the suture assembly between the first anchormember and the second anchor member.
 20. The method of claim 19, whereinthe elongated tubular implant comprises a curvilinear tube.
 21. Themethod of claim 19, wherein the elongated tubular implant is constructedto promote bone repair.
 22. The method of claim 19, wherein the sutureassembly includes a suture loop.
 23. The method of claim 22, wherein thesuture loop is formed using a self-locking slip knot.
 24. The method ofclaim 19, wherein the suture assembly includes a second free end that islocated outside the elongated tubular implant via a second portion ofthe suture assembly passing through a second side wall opening in theelongated tubular implant, the second side wall opening positionedbetween the first end of the elongated tubular implant and the secondend of the elongated tubular implant, the second free end of the sutureassembly pullable to tension the suture assembly between the firstanchor member and the second anchor member.
 25. A method of repairingtissue in a patient, comprising: locating a first bone anchor in a firsttissue region in the patient; locating a second bone anchor in a secondtissue region in the patient, the first tissue region spaced apart fromthe second tissue region in the patient; locating a bone repair assemblyin the patient, the bone repair assembly including a tensioning sutureand an elongated tubular implant received on the tensioning suture,wherein the first bone anchor is connected to the second bone anchor viathe tensioning suture, the tensioning suture including a first portionthat extends from inside the elongated tubular implant to outside theelongated tubular implant through a side wall opening in the elongatedtubular implant, the side wall opening positioned between a first end ofthe elongated tubular implant and a second end of the elongated tubularimplant; and pulling the first portion of the tensioning suture so as totension the tensioning suture between the first bone anchor and thesecond bone anchor.
 26. The method of claim 25, wherein, prior to saidpulling, the first bone anchor is positioned away from the first end ofthe elongated tubular implant and the second bone anchor is positionedaway from the second end of the elongated tubular implant, and whereinsaid pulling draws the first bone anchor toward the first end of theelongated tubular implant and draws the second bone anchor toward thesecond end of the elongated tubular implant.
 27. The method of claim 25,wherein the tensioning suture extends through a first open end of theelongated tubular implant, longitudinally through the elongated tubularimplant, and through a second open end of the elongated tubular implant.28. The method of claim 25, wherein at least one of the first boneanchor and the second bone anchor comprises a deformable anchor that isdeformable from a first shape to a second shape that is different thanthe first shape.
 29. The method of claim 25, wherein the tensioningsuture passes through at least one of the first bone anchor and thesecond bone anchor.
 30. The method of claim 25, wherein the firstportion of the tensioning suture includes a first free end locatedoutside the elongated tubular implant.
 31. The method of claim 25,wherein the tensioning suture incorporates a tensionable suture loop.32. A method of repairing tissue, comprising: implanting a tissue repairapparatus in a patient to connect a first tissue region to a secondtissue region, the first tissue region spaced apart from the secondtissue region in the patient, wherein said implanting includes: locatinga first anchor member in the first tissue region; locating a secondanchor member in the second tissue region; locating an elongated tubularimplant between the first tissue region and the second tissue region,wherein the elongated tubular implant is received on a suture assemblythat connects the first anchor member to the second anchor member, thesuture assembly including a first free end that is located outside theelongated tubular implant via a first portion of the suture assemblypassing through a first side wall opening in the elongated tubularimplant, the first side wall opening positioned between a first end ofthe elongated tubular implant and a second end of the elongated tubularimplant; and pulling the first free end of the suture assembly so as totension the suture assembly between the first anchor member and thesecond anchor member.
 33. The method of claim 32, wherein the sutureassembly extends longitudinally through the elongated tubular implant.34. The method of claim 32, wherein at least one of the first tissueregion and the second tissue region comprises bone tissue.
 35. Themethod of claim 32, wherein the suture assembly passes through anopening in the first end of the elongated tubular implant and through anopening in the second end of the elongated tubular implant.
 36. Themethod of claim 32, wherein the suture assembly includes a length ofsuture extending longitudinally through the elongated tubular implantfrom the first anchor member to the second anchor member without passingthrough a side wall of the elongated tubular implant.
 37. The method ofclaim 32, wherein the elongated tubular implant is formed with asolid-wall material.
 38. The method of claim 32, wherein the sutureassembly includes a suture loop.
 39. The method of claim 32, wherein thesuture assembly comprises a tensionable suture loop, at least a portionof the tensionable suture loop extending longitudinally through theelongated tubular implant between the first anchor member and the secondanchor member.